Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-30T19:40:31.840Z Has data issue: false hasContentIssue false
  • English
  • Français

The DST and its Relationship to Psychiatric Diagnosis, Symptoms and Treatment Outcome

Published online by Cambridge University Press:  29 January 2018

Helmfried E. Klein ,
Wolfram Bender ,
Hermann Mayr ,
Alois Niederschweiberer  and
Max Schmauss
Helmfried E. Klein*
Affiliation:
Fachklinik für Psychiatrie und Neurologie, Universitätsstrasse 84, 8400 Regensburg, West Germany; Psychiatrische Klinik der Universität München, Nussbaumstrasse 7, 8000 München 2, West Germany
Wolfram Bender
Affiliation:
Postfach 1111,8013 Haar, West Germany; Psychiatrische Klinik der Universität München
Hermann Mayr
Affiliation:
Kreiskrankenhaus Fürstenfeldbruck; Psychiatrische Klinik der Universität München
Alois Niederschweiberer
Affiliation:
Kreiskrankenhaus Landshut; Psychiatrische Klinik der Universität München
Max Schmauss
Affiliation:
Klinik der Universität München
*
Reprint requests
Get access Rights & Permissions [Opens in a new window]

Summary

The dexamethasone suppression test (DST) was administered shortly after admission to 102 consecutive in-patients with a Hamilton depression score ≥16. Post-dexamethasone cortisol exceeded 6pg/dl in 16 cases, and levels correlated significantly with Hamilton scores; with the AMP syndromes ‘hypochondria’, ‘apathy’ and ‘catatonia’; and with the IMPS ‘retarded depressive’ syndrome. The criterion of suppression/non-suppression did not distinguish significantly between diagnostic categories (RDC or ICD), nor between endogenous and neurotic depression. (Newcastle scale). Both base-line and post-dexamethasone cortisol levels were reduced by prior treatment with minor tranquillisers, but not by major tranquillisers or antidepressants. DST results cannot be used as straightforward indicators of prognosis.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 145 , Issue 6 , December 1984 , pp. 591 - 599
Copyright
Copyright © 1984 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Amsterdam, J. D., Winokur, A., Caroff, S. N. & Conn, J. (1982) The dexamethasone suppression test in outpatients with primary affective disorder and healthy control subjects. American Journal of Psychiatry, 139, 287–291.Google Scholar
Baumann, U. & Angst, J. (1975) Arbeitsgemeinschaft für Methodik und Dokumentation in der Psychiatrie (Methodological developement of the AMP-system). In Proceedings of the 9th CI NP Congress in Neuropsychopharmacology. Amsterdam: Excerpta Medica.Google Scholar
Berger, M., Doerr, P., Lund, R., Bronisch, T. & von Zerssen, D. (1982 a) Neuroendocrinological and neurophysiological studies in major depressive disorders: Are there biological markers for the endogenous sub-type? Biological Psychiatry; 17, 1217–1242.Google Scholar
Berger, M. Krieg, J. C. & Pirke, K. M. (1982 b) Is the positive dexamethasone-test in depressed patients a consequence of weight loss? (letter) Neuroendocrinology, 4(3), 177.Google Scholar
Berger, M. Pirke, K. M., Doerr, P., Krieg, J. C. & von Zerssen, D. (1984) The limited utility of the dexamethasone suppression test for the differential-diagnostic process in psychiatry, British Journal of Psychaitry, 145, 000–000.Google Scholar
Blumenfield, M., Rose, L. I., Richmond, L. H. et al (1970) Dexamethasone suppression in basic trainees under stress. Archives of General Psychiatry, 23, 299–304.Google Scholar
Brown, A. & Qualls, C. B. (1982) Pituitary-adrenal assessment in identifying subtypes of depression. Psychopharmacology Bulletin, 18 (3), 84–86.Google Scholar
Brown, A. & Shuey, I. (1980) Response to-dexamethasone and subtype of depression Archives of General Psychiatry, 37, 747–751.Google Scholar
Brown, A. Johnston, R. & Mayfild, D. (1979) The 24-hour dexamethasone suppression test in a clinical setting: Relationship to diagnosis, symptoms and response to treatment. American Journal of Psychiatry, 136, (4B), 543–547.Google Scholar
Bursten, B. & Russ, J. J. (1965) Preoperative psychological state and corticosteroid levels of surgical patients. Psychosomatic Medicine, 27, 309–316.CrossRefGoogle ScholarPubMed
Carney, M. W. P., Roth, M. & Garside, R. F. (1965) The diagnosis of depressive syndromes and the prediction of ECT response. British Journal of Psychiatry, 111, 659–674.Google Scholar
Caroff, S., Winokur, A., Rieger, W., Schweizer, E. & Amsterdam, J. (1983) Response to dexamethasone in psychotic depression. Psychiatry Research, 8, 59–64.Google Scholar
Carroll, B. J. (1972) The hypothalamic-pituitary-adrenal axis in depression. In Depressive Illness: Some Research Studies, (eds Davies, B., Carroll, B. J. & Mowbray, R. M.) Springfield, Illinois: Charles C. Thomas.Google Scholar
Carroll, B. J. (1976) Limbic system adrenal cortex regulation in depression and schizophrenia. Psychosomatic Medicine, 38 (2), 106–121.Google Scholar
Carroll, B. J. (1982a) Clinical applications of the dexamethasone suppression test for endogenous depression. Pharmacopsychiatry, 15, 19–24.CrossRefGoogle ScholarPubMed
Carroll, B. J. (1982b) The dexamethasone suppression test for melancholia. British Journal of Psychiatry, 140, 292–304.Google Scholar
Carroll, B. J. & Curtis, G. C. (1976) Neuroendocrine identification of depressed patients. Australian and New Zealand Journal of Psychiatry, 10, 13–20.CrossRefGoogle ScholarPubMed
Carroll, B. J. Martin, F. J. R. & Davies, B. (1968) Resistance to suppression by dexamethasone of plasma 11-OHCS levels in severe depressive illness. British Medical Journal, iii, 285–287 Google Scholar
Carroll, B. J. Curtis, G. C. & Mendels, I. (1976a) Neuroendocrine regulation in depression. I. Limbic system-adrenocortical dysfunction. Archives of General Psychiatry, 33, 1039–1044.Google Scholar
Carroll, B. J. & Mendels, I. (1976) Neuroendocrine regulation in depression. II: Discrimination of depressed from non-depressed patients. Archives of General Psychiatry, 33, 1051–1058.CrossRefGoogle Scholar
Carroll, B. J. Feinberg, M., Greden, F. I., Tarika, I., Albala, A. A., Haskett, R. F., James, N., Kronfol, Z., Lohr, N., Steiner, M., de Vigne, I. P. & Young, E. (1981) A specific laboratory test for the diagnosis of melancholia: Standardization, validation and clinical utility. Archives of General Psychiatry, 38, 15–22.CrossRefGoogle ScholarPubMed
Coppen, A., Abou-Saleh, M., Milln, P., Metcalfe, M., Harwood, J. & Bailey, J. (1983) Dexamethasone suppression test in depression and other psychiatric illness. British Journal of Psychiatry, 142, 498–504.CrossRefGoogle ScholarPubMed
Coryell, W., Gaffney, G. & Burkhardt, P. E. (1982) DSM III melancholia and the primary-secondary distinction: a comparison of concurrent validity by means of the dexamethasone suppression test. American Journal of Psychiatry, 139(1), 120–122.Google Scholar
Endicott, J., Spitzer, R. L., Fleiss, J. L. & Cohen, J. (1976) The Global Assessment Scale. A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33, 766–771.Google Scholar
Fang, V. S., Warenica, B. & Meltzer, H. K. (1982) Dexamethasone suppression test: technique and accuracy (letter). Archives of General Psychiatry, 39, 1217.Google Scholar
Fink, R. S., Short, F., Marjot, D. H. & James, V. H. T. (1981) Abnormal suppression of plasma Cortisol during the intravenous infusion of dexamethasone to alcoholic patients. Clinical Endocrinology, 15(1), 97–102.CrossRefGoogle ScholarPubMed
Gold, M. S., Pottash, A. L. C., Extein, I. & Sweeney, D. R. (1980) Dexamethasone suppression tests in depression and response to treatment (letter). Lancet, 31 May 1980, i (8179), 1190.Google Scholar
Goldberg, I. K. (1980) Dexamethasone suppression test as indicator of safe withdrawal of antidepressant therapy (letter). Lancet, 16 Feb. 1980, i (8164), 376.Google Scholar
Graham, P. M., Booth, J., Borganga, G., Galhemage, S., Myers, C. M., Teoh, C. L. & Cox, L. S. (1982) The dexamethasone suppression test in mania. Journal of Affective Disorders, 4, 201–211.Google Scholar
Greden, J. F., Albala, A. A., Haskett, R. F., James, N. M., Goodman, L., Steiner, M. & Carroll, B. J. (1980) Normalization of dexamethasone suppression test: a laboratory index of recovery from endogenous depression. Biological Psychiatry, 15 (3), 449–458.Google Scholar
Hamilton, M. (1967) Development of a rating scale for primary depressive illness. British Journal of Clinical and Social Psychology, 6, 278–296.CrossRefGoogle ScholarPubMed
Hwu, H. G., Rudorfer, M. V. & Clayton, P. J. (1981) Dexamethasone suppression test and subtype of depression (letter). Archives of General Psychiatry, 38, 363.Google Scholar
Jiang, N. S., Machacek, D. & Wadel, O. P. (1975) Comparison of clinical assays for serum corticosteroids. Clinical Chemistry, 21, 387–391.Google Scholar
Klein, H. E. (1982) (ed.) German edition of Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders, pub. Beltz-Verlag. Original edition by Spitzer, R. L., Endicott, I. & Robins, E., pub. by New York State Psychiatric Institute (3rd ed. 1977).Google Scholar
Klein, H. E. (1984) The dexamethasone-suppression test in psychiatry: myth and realities. In Advances in Human Psychopharmacology—A Research Annual, Vol. IV, ed. Burrows, G. D. & Werry, J. S. Greenwich: Jai Press.Google Scholar
Le Fur, G., Guilloux, F., Mitrani, N., Mizoule, J. & Uzan, A. (1979) Relationships between plasma corticosteroids and benzodiazepines in stress. Journal of Pharmacology and Experimental Therapeutics, 21, 305–308.Google Scholar
Liddle, G. W. (1960) Test of pituitary adrenal suppressibility in the diagnosis of Cushings syndrome. Journal of Clinical Endocrinology, 20, 1539–1560.Google Scholar
Lorr, M., McNair, D. M., Klett, C. J. & Lasky, J. J. (1966) Inpatient Multi-Dimensional Psychiatric Scale (IMPS). Palo Alto, California: Consulting Psychologists Press.Google Scholar
Mason, J. W., Sachar, E. J., Fishman, I. R., Hamburg, D. A. & Handlon, J. H. (1965) Corticosteroid responses to hospital admission. Archives of General Psychiatry, 13, 1–8.Google Scholar
Mason, J. W., Sachar, E. J., Fishman, I. R., Hamburg, D. A. & Handlon, J. H. (1968) A review of psycho-endocrine research on the pituitary-adrenal cortical system. Psychosomatic Medicine, 30, 576–607.CrossRefGoogle Scholar
Meltzer, Y. H., Fang, V. S., Tricon, B. J., Robertson, A. & Piyaka, S. K. (1982) Effect of dexamethasone on plasma prolactin and Cortisol levels in psychiatric patients. American Journal of Psychiatry, 139, 763–768.Google Scholar
Mendlewicz, J., Charles, G. & Franckson, J. M. (1982) The dexamethasone suppression test in affective disorder: Relationship to clinical and genetic subgroups. British Journal of Psychiatry, 141 (5), 464–470.CrossRefGoogle ScholarPubMed
Nuller, I. L. & Ostroumova, M. N. (1980) Resistance to inhibiting effect of dexamethasone in patients with endogenous depression. Acta Psychiatrica Scandinavica, 61, 169–177.CrossRefGoogle ScholarPubMed
Papacostas, Y., Lee, J., Johnson, L. & Fink, M. (1980) Neuroendocrine effects of ECT. In Scientific Proceedings, Abstract, 3,35. Pub. Society of Biological Psychiatry.Google Scholar
Privitera, M. R., Greden, J. F. & Gardner, R. W. (1982) Interference by carbamazepine with the dexamethasone suppression test. Biological Psychiatry, 17 (5), 611–620.Google Scholar
Reus, V. J., Joseph, M. S. & Dallmann, M. F. (1982) ACTH levels after the dexamethasone suppression test in depression. New England Journal of Medicine, 360(4), 238–239.Google Scholar
Rothschild, A. J., Schatzberg, A. F., Rosenbaum, A. H., Stahl, J. B. & Cole, J. O. (1982) The dexamethasone suppression test as a discriminator among subtypes of psychotic patients. British Journal of Psychiatry, 141, 471–474.Google Scholar
Rudorfer, M. V., Hwu, H. G. & Clayton, O. J. (1982) Dexamethasone suppression test in primary depression: significance of family history and psychosis. Biological Psychiatry, 17 (1), 41–48.Google ScholarPubMed
Rush, A. J., Giles, D. E., Roffwarg, H. P. & Parker, C. R. (1982) Sleep EEG and dexamethasone suppression test findings in outpatients with unipolar major depressive disorders. Biological Psychiatry, 17 (3), 327–341.Google ScholarPubMed
Sachar, E. J., Hellman, L., Fukushima, D. K. & Gallagher, T. F. (1970) Cortisol production in depressive illness. Archives of General Psychiatry, 23, 289–298.CrossRefGoogle ScholarPubMed
Sachar, E. J., Hellman, L., Fukushima, D. K. & Gallagher, T. F. Roffwarg, H. P. & Halpern, F. X. (1973) Disrupted 24-hour patterns of Cortisol secretion in psychotic depression. Archives of General Psychiatry, 28, 19–24.CrossRefGoogle ScholarPubMed
Schatzberg, A. F., Rothschild, A. J., Stahl, J. B., Bond, T. C., Rosenbaum, A. H., Lofgren, S. B., Maclaughlin, R. A. Sullivan, M. A. & Cole, J. D. (1983) The dexamethasone suppression test: identification of subtypes of depression. American Journal of Psychiatry, 140 (1), 88–91.Google Scholar
Schlesser, M. A., Winokur, G. & Sherman, B. M. (1979) Genetic subtypes of unipolar primary depressive illness distinguished by hypothalamic-pituitary-adrenal axis activity. Lancet, i (8119), 739–741.Google Scholar
Shopsin, B. & Gershon, S. (1971) Plasma Cortisol response to dexamethasone suppression in depressed and control patients. Archives of General Psychiatry, 24, 320–326.Google Scholar
Shulman, R. & Diewold, P. (1977) A two-dose dexamethasone suppression test in patients with psychiatric illness. Canadian Psychiatric Association Journal, 22, 417–422.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1977) Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders, 3rd ed. New York: New York State Psychiatric Institute, Biometrics Research. German edition (1982) (ed. Klein, H. E.). Beltz-Verlag.Google Scholar
Stokes, P. E., Stoll, P. M., Mattson, M. R. & Sollod, R. N. (1976) Diagnosis and psychopathology in psychiatric patients resistant to dexamethasone. In Hormones, Behaviour and Psychopathology, ed. Sachar, E. J. New York: Raven Press.Google Scholar
Swartz, C. M. (1982) Biologically derived depression and the dexamethasone suppression test. Comprehensive Psychiatry, 23 (4), 339–344.Google Scholar
Wood, K., Harwood, J. & Coppen, A. (1983) Dexamethasone suppression test: technique and accuracy (letter). Archives of General Psychiatry, 40, 585.Google Scholar
von Zerssen, D. & Koeller, D. M. (1976) Klinische Selbstbeurteilungs-Skalen (KSB-S) aus dem Münchener Psychiatrischen Informationssystem (PSYCHIS München). Weinheim: Beltz-Verlag.Google Scholar
von Zerssen, D. & Koeller, D. M. (1979) Klinisch-psychiatrische Selbst beurteilungs-frage bögen. In Klinische Psychologie, Trends in Forschung und Praxis, ed. Baumann, U., Berbalk, H. & Seidenstücker, G. Bern, Stuttgart, Wien: Hans Huber.Google Scholar
World Health Organization (1970) Diagnoserschlüssel und Glossar psychiatrischer Krankheiten (International Classification of Diseases) 8th revision. Berlin, Heidelberg, New York: Springer Verlag.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.